University of Maryland School of Pharmacy, Baltimore, USA.
Columbia University Mailman School of Public Health, New York, NY, USA.
J Aging Health. 2020 Jan-Feb;32(1):25-32. doi: 10.1177/0898264318802047. Epub 2018 Sep 22.
This study examined screening mammograms in women aged 65 to 74 years and 75+ years before and after the Affordable Care Act (ACA) implementation. This repeated cross-sectional study of community-dwelling women age 65+ years without a history of breast cancer or mastectomy utilized the Medicare Current Beneficiary Survey and Medicare fee-for-service claims data from 2001 to 2013. We used covariate-adjusted logistic regression with generalized estimating equations, stratified by age group. The adjusted odds of screening mammograms in women aged 65-74 ( = 742) and 75+ years ( = 681) were lower in 2013 (odds ratio [OR]: 0.75, 95% confidence interval [CI]: [0.67, 0.83]; OR: 0.67, 95% CI: [0.60, 0.75], respectively) than the odds of screening mammograms in 2001. Annual screening mammograms decreased in women aged 65 to 74 years and 75+ years, despite increased access from the ACA implementation. Future research as to why women are no longer receiving screening mammograms, such as changes in physician specialty guidelines, is warranted.
本研究调查了平价医疗法案(ACA)实施前后,65 至 74 岁和 75 岁以上女性的筛查性乳房 X 光检查情况。这是一项针对无乳腺癌或乳房切除术病史的 65 岁以上社区居住女性的重复横断面研究,利用了 2001 年至 2013 年的医疗保险当前受益人和医疗保险收费服务索赔数据。我们使用了广义估计方程的协变量调整逻辑回归,按年龄组分层。在 2013 年,65-74 岁(n=742)和 75 岁及以上(n=681)女性接受筛查性乳房 X 光检查的调整后几率(OR)分别低于 2001 年(OR:0.75,95%置信区间[CI]:[0.67,0.83];OR:0.67,95%CI:[0.60,0.75])。尽管 ACA 的实施增加了获得筛查性乳房 X 光检查的机会,但 65 岁至 74 岁和 75 岁及以上女性的年度筛查性乳房 X 光检查次数减少。需要进一步研究为什么女性不再接受筛查性乳房 X 光检查,例如医生专业指南的变化。